Paediatric & Adult Dosages of Antibiotics for Prophylaxis of Sexually Transmitted Diseases (STD)

	Ceftriaxone	Azithromycin (PO)	Metronidazole (PO)
BNFC v3.0.6 (828) Updated on 2 Dec 2020	Uncomplicated gonorrhea (by deep IM) ·       1 month – 12 years (<45 kg): 125 mg STAT ·       2-12 years (≥45 kg): 250 mg STAT ·       13-15 years: 500 mg STAT ·       Adult: 1 g STAT   *Neonatal congenital gonococcal conjunctivitis: IM Cefotaxime 100 mg/kg (max 1 g) STAT	Uncomplicated genital chlamydial infections / Non-gonococcal urethritis 12-17 years or adult: 1 g STAT   Uncomplicated gonorrhea: ·       13-15 years: 1g STAT (in combination with other antibiotics) OR 2 g STAT (as monotherapy) ·       16-17 years or adult: 2 g STAT	Urogenital trichomoniasis: ·       1-2 years: 50 mg TDS for 7 days ·       3-6 years: 100 mg BD for 7 days ·       7-9 years: 100 mg TDS for 7 days ·       10-17 years or adult: ü 200 mg TDS for 7 days OR ü 400-500 mg BD for 5-7 days OR ü 2 g STAT
Lexicomp v5.9.2	Gonococcal infections IM/IV: Neonatal: 25-50 mg/kg STAT (max 125 mg/dose) *Administer cautiously to hyperbilirubinemic neonates, esp those born premature; alternative agent may be necessary   Gonococcal infections, treatment – uncomplicated cervicitis, pharyngitis, proctitis, urethritis and vulvovaginitis: ·        Infants & children ≤ 45 kg: IM/IV: 25-50 mg/kg STAT; max 125 mg/dose ·        Children > 45 kg, adolescents & adult: IM 250 mg STAT with a single oral dose of azithromycin   Prophylaxis against STD following sexual assault: Adolescents and adult: IM: 250 mg STAT with a single dose of oral azithromycin and oral metronidazole	Chlamydia trachomatis infection: Urogenital / anogenital or oropharyngeal infection: Children < 8 years with BW ≥45 kg or Children ≥ 8 years / adolescents / adult: PO 1 g STAT   Sexual victimization, prophylaxis: Adolescents & adults: 1 g STAT in combination with ceftriaxone and metronidazole.	Prophylaxis against sexually transmitted diseases following sexual assault: Adolescents: Oral: 2 g STAT with azithromycin and ceftriaxone.   Trichomoniasis, treatment: ·        < 45 kg: 15 mg/kg TDS for 7 days; max daily dose is 2 g   ·       ≥ 45 kg and adolescents: 500 mg BD for 7 days OR 2 g STAT (Note: 7-day-course has been shown to be more effective in adult women)   ·       Adult: 500 mg BD for 7 days (2 g STAT less preferred due to inferior efficacy)
Micromedex v2.5b851	Uncomplicated gonorrhea: ≤ 45 kg : IV/IM 25-50 mg/kg STAT (max 125 mg/dose) > 45 kg : IM 250 mg IM STAT plus PO Azithromycin 1g STAT Adult : Same as > 45 kg	Chlamydia trachomatis infection (cervicitis or urethritis): ≥ 45 kg OR ≥ 8 years old : 1 g STAT	STD prophylaxis – victim of sexual aggression (Adult) : PO 2 g STAT + IM Ceftriaxone 250 mg STAT + PO Azithromycin 1 g STAT   Trichomoniasis (Adult): 2 g STAT (preferred, esp when pregnant) + 500 mg BD for 7 days
UptoDate: Evaluation and management of adult and adolescent sexual assault victims (Updated 25.11.2019)	Gonorrhea treatment: IM Ceftriaxone 250 mg STAT	Chlamydia treatment: PO 1 g STAT	Trichomoniasis treatment: PO 2 g STAT
Mollen CJ et al. Acute Sexual Assault. Pediatr Emer Care 2012;28: 584-593	Gonorrhea prevention: < 45 kg: IM 125 mg STAT ≥ 45 kg: IM 250 mg STAT	Chlamydia prevention: < 45 kg: PO 20 mg/kg (max 1 g) STAT ≥ 45 kg: PO 1 g STAT	Trichomoniasis / BV (bacterial vaginosis) prevention: < 45 kg: PO 15 mg/kg per day in 3 divided doses (max 2 g)  [?] ≥ 45 kg: PO 2 g STAT
Sexually Transmitted Diseases Treatment Guidelines, 2015 (CDC)	IM Ceftriaxone 250 mg STAT	PO 1 g STAT	PO 2 g STAT
Likas Protocol (no age range / body weight specified)	IM 125 mg STAT	PO 20 mg/kg STAT	PO 15 mg/kg STAT
National Antimicrobial Guideline 2019 (Malaysia) – For Adult	Uncomplicated Gonorrhea (Urogenital, Anorectal, Pharyngeal) (including if pregnant): IM 500 mg STAT + PO Azithromycin 1 g STAT	Uncomplicated Chlamydia (urogenital, pharyngeal and rectal infection): PO 1 g STAT, then 500 mg OD x 2/7 OR PO Doxycycline 100 mg BD x 7/7	Trichomoniasis treatment: ·       400 mg BD x 5-7 days OR ·       400 mg TDS for 7 days (in O&G) OR ·       2 g STAT

 

 

Sexually Transmitted Diseases Treatment Guidelines, 2015 (CDC)                                                                  https://www.cdc.gov/std/tg2015/tg-2015-print.pdf
§ If alcohol has been recently ingested or emergency contraception is provided, metronidazole or tinidazole can be taken by the sexual assault survivor at home rather than as directly observed therapy to minimize potential side effects and drug interactions.	§ Postexposure hepatitis B vaccination (without HBIG) if the hepatitis status of the assailant is unknown and the survivor has not been previously vaccinated. If the assailant is known to be HBsAg-positive, unvaccinated survivors should receive both hepatitis B vaccine and HBIG. The vaccine and HBIG, if indicated, should be administered to sexual assault survivors at the time of the initial examination, and follow-up doses of vaccine should be administered 1–2 and 4–6 months after the first dose. Survivors who were previously vaccinated but did not receive postvaccination testing should receive a single vaccine booster dose.	§ HPV vaccination is recommended for female survivors aged 9–26 years and male survivors aged 9–21 years. For MSM with who have not received HPV vaccine or who have been incompletely vaccinated, vaccine can be administered through age 26 years. The vaccine should be administered to sexual assault survivors at the time of the initial examination, and follow-up dose administered at 1–2 months and 6 months after the first dose

 

Updated by JCK Ho @ 30.12.2020

Administration Guide : Terlipressin

TERLIPRESSIN  1 MG INJECTION			HIGH ALERT MEDICATION
ROUTE	DILUTION	RUN RATE
INTRAVENOUS Bolus	Undiluted 1	Over 1 min 2,3,6
INTRAVENOUS Infusion   (Typically for Type 1 Hepatorenal Syndrome)	In studies, 1-3 mg was taken and diluted in (qs up to) 50 mL D5	Run over 24 hrs   Run rate = 2.08 mL/hr
	1 mg in 50 mL D5 = 0.02 mg/mL 7
	2 mg in 50 mL D5 = 0.04 mg/mL 8,9
	3 mg in 50 mL D5 = 0.06 mg/mL 10
DILUENT	Usually NOT required If further dilution is required, suggest to use D5 (better stability than NS) 7
STABILITY	Unopened: Store at 2-8°C in original packaging 1,4,5 Stability: Use immediately 2,4 , however, solution of 2mg/50ml has been shown to be stable for up to 24 hrs at room temperature.11
REMARKS	§ Caution: Hypertension, atherosclerosis, cardiac dysrhythmias or coronary insufficiency. 4 § Contraindication: unstable angina, recent MI, septic shock with low cardiac output, pregnancy. 5
DOSE	1 mg terlipressin acetate = 0.85 mg terlipressin free base ; typical dosing is based on terlipressin acetate   Bleeding Oesophageal Varices 1,3-5 * Initial dose: IV 2 mg STAT or 2 mg q4-6h until bleeding has been controlled for at least 24 hours or up to 36-72 hours. Some manufacturers provide dosage adjustments based on body weight: 2,5,6 < 50 kg = 1 mg 50-70 kg = 1.5 mg > 70 kg = 2 mg  * Maintenance dose: 1-2 mg q4-6h for 2-5 days (typically 1 mg/dose).  * Notes from other references: ·         After the initial dose, may consider reduce dose to 1 mg q4h for those with body weight <50 kg or if adverse effects occur. 1 ·         From FUKKM: Maximum daily dosage: 120-150 mcg/kg body weight. 2,3   Type 1 Hepatorenal Syndrome (Off label)1 ü  DO NOT USE SURGICAL STOCK unless authorised by HKGU surgeon. ü  Need to obtain approval for Ubat Kelulusan Khas (UKK) / KPK for both terlipressin and human albumin. *1 mg QID via slow bolus inj, may be increased up to max 2 mg 4-6 hourly if serum creatinine has not been reduced by at least 25% after 3 days. Max duration of treatment: 2 weeks.5 *Increasing evidence has shown that continuous infusion demonstrating a similar rate of response (more stable lowering effect on portal pressure) but lower adverse effects than the administration of the drug by i.v. boluses.8 Shock (Off label) 4 1-2 mg of terlipressin acetate by IV injection produced a progressive increase in mean arterial pressure over 10-20 minutes, that was sustained at least 5 hours, allowing reduction or cessation of noradrenaline therapy. 4
REFERENCES	1.          Product leaflet (GLYPRESSIN - Ferring) 2.          https://www.drugs.com/uk/terlipressin-acetate-1-mg-solution-for-injection-leaflet.html [Accessed 16 Nov 2020] 3.          Formulari Ubat Kementerian Kesihatan Malaysia: Online [Accessed 16 Nov 2020] 4.          Alistair G., Jane W., Vincent G., Lynn B. Injectable Drugs Guide. London:(PhP) Pharmaceutical Press 5.          Mimsgateway: Drug Information: Terlipressin [ Accessed 17 Nov 2020] 6.          UptoDate [Multi Drug National] : Drug Information: Terlipressin [Acessed 17 Nov 2020] 7.          Rodriguez-Nunez et al. Terlipressin Continuous Infusion: Please Mind the Solvent! Current Drug Targets, 2009, Vol. 10, No. 6 577 8.          Cavallin M et al. Terlipressin Given by Continuous Intravenous Infusion Versus Intravenous Boluses in the Treatment of Hepatorenal Syndrome: A Randomized Controlled Study. Hepatology, Vol.63, No.3, 2016. 9.          Angeli P et al. Switch therapy with ciprofloxacin vs. intravenous ceftazidime in the treatment of spontaneous bacterial peritonitis in patients with cirrhosis: similar efficacy at lower cost. Aliment Pharmacol Ther, 23, 75–84 10.      Hospital Selayang Terlipressin Administration Protocol [Accessed on 2 Dec 2020] 11.      An investigation of reconstituted terlipressin infusion stability for use in hepatorenal syndrome. Nature (2020) 10:21037. https://doi.org/10.1038/s41598-020-78044-4 12.      Jha et al. Comparison of continuous versus intermittent infusions of terlipressin for the control of acute variceal bleeding in patients with portal hypertension: An open-label randomized controlled trial. Indian Journal of Gastroenterology Vol. 37, pg 313–320(2018)